Comparative study of the Ambu® AuraOnce™ laryngeal mask and endotracheal intubation in anesthesia airway management during neurosurgery

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Abstract

Objective

To investigate the feasibility and efficacy of the Ambu® AuraOnce™ laryngeal mask (LMA) compared with endotracheal intubation (ETI) during supratentorial tumor resection in the right lateral decubitus position.

Methods

This was a randomized controlled trial of LMA compared with ETI in patients who were scheduled to undergo supratentorial tumor resection in the right lateral decubitus position. The patients were randomized to the LMA (n = 40) and ETI groups (n = 40). The hemodynamic parameters (primary outcome) and mechanical ventilation parameters, anesthetic dose, and complications as well as quality of anesthesia recovery (secondary outcomes) were compared.

Results

Patients in the LMA group exhibited lower mean arterial pressure (MAP) and heart rate (HR) compared with ETI. Nine and two patients received esmolol during intubation and extubation, respectively. The airway pressure (AP) in the LMA group was higher compared with the ETI group 60 minutes after the start of surgery. Compared with the ETI group, the sufentanil dose was lower by 24% and the anesthesia recovery rate was better in the LMA group.

Conclusions

LMA can improve hemodynamic stability in patients undergoing supratentorial tumor resection in the right lateral decubitus position. If there is a clinical need and no contraindication, LMA could replace ETI.

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Most cited references 39

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Pharmacokinetic model driven infusion of propofol in children.

Anna N. Morton, Megan M. White, John Kenny … (1991)

A computer controlled infusion device for propofol was used to induce and maintain general anaesthesia in 20 children undergoing minor surgical procedures. The device was programmed with an adult pharmacokinetic model for propofol. During and after anaesthesia, blood samples were taken for measurement of propofol concentrations and it was found that the values obtained were systematically overpredicted by the delivery system algorithm. New pharmacokinetic microconstants were derived from our data which reflected more accurately the elimination and distribution of propofol in a prospective study involving another 10 children.

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Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients.

Matthew Keller, J Brimacombe, Sheldon R. Morris … (1999)

We have compared four tests for assessing airway sealing pressure with the laryngeal mask airway (LMA) to test the hypothesis that airway sealing pressure and inter-observer reliability differ between tests. We studied 80 paralysed, anaesthetized adult patients. Four different airway sealing pressure tests were performed in random order on each patient by two observers blinded to each other's measurements: test 1 involved detection of an audible noise; test 2 was detection of end-tidal carbon dioxide in the oral cavity; test 3 was observation of the aneroid manometer dial as the pressure increased to note the airway pressure at which the dial reached stability; and test 4 was detection of an audible noise by neck auscultation. Mean airway sealing pressure ranged from 19.5 to 21.3 cm H2O and intra-class correlation coefficient was 0.95-0.99. Inter-observer reliability of all tests was classed as excellent. The manometric stability test had a higher mean airway sealing pressure (P < 0.0001) and better inter-observer reliability (P < 0.0001) compared with the three other tests. We conclude that for clinical purposes all four tests are excellent, but that the manometric stability test may be more appropriate for researchers comparing airway sealing pressures.

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Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success.

P A Klock, Rodolfo Hernández-Gutiérrez, A Ovassapian (2012)

The development of the laryngeal mask airway in 1981 was an important first step toward widespread use and acceptance of the extraglottic airway (EGA). The term extraglottic is used in this review to encompass those airways that do not violate the larynx, in addition to those with a supraglottic position. Although the term extraglottic may be broad and include airways such as tracheostomy tubes, the term supraglottic does not describe a large number of devices with subglottic components and is too narrow for a discussion of modern devices. EGAs have flourished in practice, and now a wide variety of devices are available for an ever-expanding array of applications. In this review we attempt to clarify the current state of EGA devices new and old, and to illustrate their use in numerous settings. Particular attention is paid to the use of EGAs in special situations such as obstetric, pediatric, prehospital, and nontraditional "out of the operating room" settings. The role of the EGA in difficult airway management is discussed. EGA devices have saved countless lives because they facilitate ventilation when facemask ventilation and tracheal intubation were not possible. Traditionally, difficult airway management focused on successful tracheal intubation. The EGA has allowed a paradigm shift, changing the emphasis of difficult airway management from tracheal intubation to ventilation and oxygenation. EGA devices have proved to be useful adjuncts to tracheal intubation; in particular, the combination of EGA devices and fiberoptic guidance is a powerful technique for difficult airway management. Despite their utility, EGAs do have disadvantages. For example, they typically do not provide the same protection from pulmonary aspiration of regurgitated gastric material as a cuffed tracheal tube. The risk of aspiration of gastric contents persists despite advances in EGA design that have sought to address the issue. The association between excessive EGA cuff pressure and potential morbidity is becoming increasingly recognized. The widespread success and adoption of the EGA into clinical practice has revolutionized airway management and anesthetic care. Although the role of EGAs is well established, the user must know each device's particular strengths and limitations and understand that limited data are available for guidance until a new device has been well studied.

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Author and article information

Journal

Journal ID (nlm-ta): J Int Med Res

Journal ID (iso-abbrev): J. Int. Med. Res

Journal ID (publisher-id): IMR

Journal ID (hwp): spimr

Title: The Journal of International Medical Research

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 0300-0605

ISSN (Electronic): 1473-2300

Publication date (Electronic): 10 February 2020

Publication date Collection: February 2020

Volume: 48

Issue: 2

Electronic Location Identifier: 0300060520902606

Affiliations

[1 ]Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing, China

[2 ]Intensive Care Unit, Sanbo Brain Hospital, Capital Medical University, Beijing, China

Author notes

[*]Baoguo Wang, Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, 50 Yikesong Road, Beijing 100093, China. Email: wbgsbnk@ 123456163.com

Author information

Baoguo Wang https://orcid.org/0000-0001-6879-8491

Article

Publisher ID: 10.1177_0300060520902606

DOI: 10.1177/0300060520902606

PMC ID: 7111043

PubMed ID: 32036718

SO-VID: 579a8416-c179-4de9-9e9a-cd1b21c9eb4a

License:

Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 23 July 2019

Date accepted : 7 January 2020

Funding

Funded by: National key basic research development programme (973 programme);

Award ID: No. 2013CB531901

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Keywords: laryngeal mask,endotracheal intubation,neurosurgical anesthesia,airway management,comparative study,hemodynamic stability,supratentorial tumor resection

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Keywords: laryngeal mask, endotracheal intubation, neurosurgical anesthesia, airway management, comparative study, hemodynamic stability, supratentorial tumor resection

Comparative study of the Ambu® AuraOnce™ laryngeal mask and endotracheal intubation in anesthesia airway management during neurosurgery

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Abstract

Objective

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Results

Conclusions

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International Journal of Medicine and Medical Research

Most cited references 39

Pharmacokinetic model driven infusion of propofol in children.

Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients.

Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success.

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